Smart system of disease management for patient follow-up and medication refill during the COVID-19 epidemic period: a multicentre retrospective cohort study

BACKGROUND: An outbreak of coronavirus disease 2019 (COVID-19) started in December, 2019. The epicentre, Wuhan in Hubei Province, was in lockdown. From Jan 23, 2020, most hospitals in Wuhan only focused on patients with COVID-19, and patients with chronic diseases could not visit their physicians in clinic and had no access to prescriptions. Smart System of Disease Management (SSDM) is a series of mobile applications for chronic disease management that includes both patient and physician interfaces. After training in clinic, patients regularly do a disease activity assessment, and input data from lab tests as well as their medication. The data is then synchronised to the mobile of the responsible physician. The physician can then do an online consultation and renew prescriptions on the basis of real-time data from his or her patients. We aimed to establish the feasibility and effects of SSDM in maintaining effective interactions between patients and physicians in Hubei province during the COVID-19 epidemic period. METHODS: Based on the SSDM database, we did a multicentre retrospective cohort study of patients with rheumatic disease in Hubei province in China. SSDM had been widely used across China since 2015. To study the influence of interruption of routine care by the COVID-19 epidemic for patients with rheumatic disease, we included patients registered with SSDM from Hubei Province. Data on patient disease activities, online consultations, and prescription refilling, as well as surveys on satisfaction about the online service were extracted from Jan 23, 2020 to Feb 27, 2020, acting as the study group, and data from the same period during 2018 and 2019 were also extracted as a control. Inclusion criteria included a confirmed diagnosis of rheumatic disease and disease duration of at least 3 months. Patients were excluded from the study if they declined participation or discontinued before completion of the survey. For patients with rheumatoid arthritis, achieving a disease activity score with 28 joints (DAS28) of less than 3·2 was considered to be a treat-to-target (T2T) status. For patients with systemic lupus erythematosus, a disease activity index-2000 (SLESAI-2K) score of less than 4 was the main target of the lupus low disease-activity state (LLDAS). We compared the T2T and LLDAS prevalence during the epidemic period of 2020 with that of 2018 and 2019. All statistical analyses were done with Python version 3.7.4. We used descriptive and frequency statistics (percentage) to describe baseline demographic information and clinical information. Comparison of ratio variables between two groups was done with a χ(2) test. FINDINGS: By Feb 27, 2020, a total of 173 560 adult patients (46 861 [27%] men and 126 699 [73%] women) with rheumatic disease from 860 hospitals across China registered and routinely used SSDM since 2015. Patients were encouraged to upload their data and do a disease activity self-assessment every 1–3 months. 10 441 (6%) of 173 560 patients (3237 [31%] with rheumatoid arthritis and 1566 [15%] with systemic lupus erythematosus) were managed by 176 rheumatologists from 42 hospitals in Hubei province. From Jan 23, 2020 to Feb 27, 2020, 69 rheumatologists from 28 hospitals provided 1451 patients with 1692 consultations and supplied 566 (39%) of them with continued medication, which included 55 commonly used therapeutic drugs for rheumatic diseases. 247 (8%) of 3237 patients with rheumatoid arthritis during the 2020 epidemic and 350 (9%) in same period during 2018 and 2019 did the DAS28 self-assessments, and T2T was 47% in 2020 compared with 50% in 2018 and 2019, (p=0·53). 293 (19%) of 1566 patients with systemic lupus erythematosus in 2020 and 210 (16%) in 2018 and 2019 did the SLESAI-2K self-assessments, and LLDAS was 60% in 2020 compared with 47% in 2018 and 2019 (p=0·03). Surveys showed that 100% of patients were satisfied with the interactions, which prevented the risk of cross-infection and discontinuation of medication. INTERPRETATION: Patients with rheumatism can maintain accessibility to good care in the era of the COVID-19 epidemic by using SSDM for consultations and medication refills. The clinical outcomes, at least for both rheumatoid arthritis and systemic lupus erythematosus, are not compromised. FUNDING: None.